Molina Healthcare

Senior Specialist, Coding (Remote)

Molina Healthcare$75K — $95K *
US-AnywhereRemote in Long Beach, CA
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • Associate's Degree or equivalent work experience.
  • 3-5+ years of coding, payment integrity, or claims experience in a healthcare setting.
  • Active and unrestricted coding certification (CPC, CCS, CCS-P, RHIT, or similar).
  • Experience in coding accuracy and operational workflows.
  • Preferred: Bachelor's Degree in Business, Healthcare, or related field.

Responsibilities

  • Serve as subject matter expert and primary contact for assigned Health Plans.
  • Research and analyze correct coding edit accuracy and savings.
  • Apply relevant state, federal, and vendor coding guidelines to inquiries.
  • Review edit outcomes for inconsistencies and improvement opportunities.
  • Monitor coding trends, savings indicators, and performance outcomes.
  • Support resolution of coding inquiries impacting assigned work.
  • Communicate insights, findings, and observations to stakeholders.

Benefits

  • Comprehensive benefits package including health, dental, and vision coverage.
  • 401(k) plan with company match.
  • Flexible work arrangements.
  • Continuous education and professional development opportunities.
Full Job Description
Job Description

Job Description:

The Senior Specialist, Coding Research supports Payment Integrity Prepay operations by researching correct coding edit inquiries, analyzing edit outcomes, validating coding rationale, and monitoring savings and accuracy trends within assigned scope. This role partners with Health Plans, vendors, and internal stakeholders to support consistent application of coding guidelines, timely issue resolution, savings integrity, and accurate claim edit outcomes.

Essential Job Duties:

  • Serve as the primary subject matter expert and Health Plan point of contact for assigned state(s), Health Plans, or edit categories.


  • Research, analyze, and support correct coding edit accuracy and savings for assigned work.


  • Apply state, federal, industry, and vendor coding guidance when researching correct coding edit outcomes.


  • Review edit outcomes and coding rationale to identify inconsistencies, risks, savings impact, and improvement opportunities.


  • Monitor coding-related trends, savings indicators, and performance outcomes to identify potential variations.


  • Support day-to-day triage and resolution of coding edit inquiries impacting assigned work.


  • Assist in resolving coding edit questions, savings inquiries, and escalations from Health Plans and internal teams.


  • Partner with prepay editing vendors and internal stakeholders to research inquiries and clarify coding edit expectations.


  • Communicate coding insights, edit findings, and savings-related observations to internal stakeholders and Health Plan partners.


  • Provide recommendations to improve consistency, edit accuracy, and coding outcome quality.


  • Support development of job aids, training materials, and team guidance related to correct coding edit accuracy.


  • Apply subject matter knowledge to support coding edit processes, initiatives, and accurate outcomes.


Job Requirements:

  • Associate's Degree or equivalent work experience.


  • 3-5+ years of coding, payment integrity, or claims experience in a healthcare setting.


  • Experience supporting coding accuracy, correct coding edit review, savings analysis, and operational workflows.


  • Active and unrestricted coding certification, such as CPC, CCS, CCS-P, RHIT, or equivalent.


Preferred Qualifications:

  • Bachelor's Degree in Business, Healthcare, or a related field.


  • Experience in prepayment coding programs and payer environments.


  • Exposure to working with coding vendors and Health Plan partners.


  • Familiarity with state-specific coding and reimbursement guidelines.


  • Proficiency in Excel for tracking, reporting, and trend identification.


To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package.

About Molina Healthcare

Molina Healthcare focuses exclusively on government-sponsored health care programs for families and individuals who qualify for government-sponsored health care. It contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals.

Molina Healthcare Careers

Join the dedicated team at Molina Healthcare, a leader in providing quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and Medicare. As one of the most respected companies in the health services industry, Molina Healthcare offers unparalleled job opportunities aimed at empowering your career growth and professional development.

Work You’ll Do

At Molina Healthcare, you will engage in meaningful work that directly impacts lives across the country. Our team is committed to innovation in healthcare, ensuring that all members receive the best care possible. By joining us, you will collaborate with skilled professionals dedicated to our mission of providing accessible, high-quality healthcare.

Career Opportunities and Growth

Whether you are looking for your first job, seeking a leadership role, or aiming to specialize in healthcare professions, Molina Healthcare offers a range of career paths. Our job opportunities span across various functions, including clinical services, customer support, IT, project management, and more. We believe in fostering the growth of our employees through professional development, leadership training, and diversity initiatives.

Internship Programs

Kickstart your career with a Molina Healthcare internship. Our internships provide invaluable workplace experience, offering a glimpse into the healthcare industry through hands-on projects and mentorship. Interns at Molina Healthcare gain critical skills that prepare them for future employment, making them competitive candidates in the job market.

Culture and Benefits

Molina Healthcare is not just a company; it’s a community. We prioritize a culture of inclusivity and respect, where all team members are encouraged to bring their whole selves to work. Our employees enjoy comprehensive benefits, including health insurance, retirement plans, and wellness programs, all designed to support both their professional and personal lives.

Join Our Team

Explore the various positions available at Molina Healthcare and find where your skills and interests align with our needs. We are continuously hiring talented individuals who are passionate about making a difference in healthcare. Prepare your resume, sharpen your interview skills, and become part of a team that values hard work and creativity.

Stay Connected

Keep up to date with the latest at Molina Healthcare: - **Career Growth and Networking:** Advance your career through our professional development and networking opportunities. Learn from leaders and peers alike to build connections that propel your career forward. - **Innovation and Leadership:** Drive change and lead with confidence by participating in our leadership and innovation training programs.

Apply Now

Ready to take the next step in your healthcare career? Search open positions that match your skills and interests on the Molina Healthcare Jobs portal. We look for driven, curious, and compassionate team players ready to make an impact.

Stay Informed

Subscribe to Molina Healthcare job alerts and receive updates on new openings and company news directly to your inbox. Tailor your subscription to match your career preferences and stay ahead in the dynamic field of healthcare. Join Molina Healthcare, where your career is nurtured, your contributions are valued, and your growth is guaranteed.
Learn more about Molina Healthcare
Size
14,000 employees
Market Cap
$19.5 billion
Industry
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ

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